CITIA-SC
is part of a national effort to increase the use of Electronic Health
Records (EHRs) by health care providers. EHRs are a critical tool
for improving clinical effectiveness and the overall performance
of a health care system and providing more value and satisfaction
for patients.
A network of Regional Extension
Centers have been established throughout the United States to offer
technical assistance, guidance, and information on best practices
to support and speed the adoption—and the meaningful use—of EHR
systems in doctors’ offices; CITIA serves as South Carolina’s Regional
Extension Center.
CITIA has already recruited 1,000
primary care providers—approximately 21 percent of all providers
in the state. There are currently 62 Regional Extension Centers
in the United States, and South Carolina was the second in the nation
to achieve this initial benchmark. CITIA also demonstrated a focus
on helping rural areas of the state via
the fact that 81% of the practice sites recruited are in a health
professional shortage area or a medically underserved area (or both).
How CITIA works
As a Regional Extension Center,
CITIA supports health care providers in South Carolina with direct,
individualized, and on-site technical assistance in the following
areas:
- Selecting a certified EHR product that offers
the best value for the providers’ needs.
- Effectively implementing a certified EHR product.
- Enhancing clinical and administrative workflows
to best leverage an EHR system’s potential to improve quality
and value of care, including patient experience and care outcomes.
- Observing and complying with applicable regulatory,
professional, and ethical requirements to protect the integrity,
privacy, and security of patients’ health information.
How can CITIA help my practice?
- CITIA offers information about effective strategies
and practices to select, implement, and meaningfully use certified
EHR technology to improve quality and value of health care.
- CITIA will assess the health IT needs of your
practice and help you select an EHR vendor product.
- CITIA offers information on a selection of
preferred EHR vendor products vetted by an expert committee and
negotiates group pricing and purchase contracts with preferred
vendors.
- CITIA will help implement the EHR system in
your practice, including individualized and on-site coaching and
consultation.
- CITIA offers consultation regarding practice
workflow redesign necessary to achieve meaningful use of your
EHR.
- CITIA will provide information regarding best
practices with respect to the privacy and security of personal
health information.
- CITIA will review your EHR system and provide
support to help your practice achieve meaningful use as defined
by Medicare and Medicaid regulations and guidance.
- CITIA will help you achieve functional interoperability,
including the electronic exchange of information required to ensure
continuity across the spectrum of care.
- CITIA participates in the national consortium
of extension centers and its activities, and will keep all participating
providers informed about the national developments that affect
primary care providers working toward meaningful use of EHR systems.
- CITIA partners with the state technical college
system to promote integration of health IT into the initial and
ongoing training of supporting staff. Activities include internship
opportunities, expansion of didactic programs, and use of local
training programs to support retraining of your staff to address
changing workforce needs.
View a more detailed discussion
of the benefits of EHRs for medical practices.
How do I sign up my practice to participate?
- 1.Fill out an online
application at www.citiasc.org.
- 2.Complete a letter
of commitment signed by a representative authority in the practice
that contains requested demographic indicators for the practice,
demographic data for each practice site (if more than one), and
requested information about each primary care provider at each
site.
- Adopt and implement a certified EHR of your
choice.
- Demonstrate use of an EHR for quality reporting
and electronic prescribing within nine months of joining the program.
- Demonstrate "meaningful use" of the EHR within
one year of joining the program via (1) documentation from CMS
(Medicare) that individual practice providers have achieved meaningful
use, (2) documentation from a state Medicaid
program that practice providers have achieved meaningful use,
or (3) documentation using an ONC-certified tool for meaningful-use
assessment.
How much does it cost to join the program?
As the Regional Extension Center
for South Carolina, CITIA is dedicated to helping primary care providers
understand and take full advantage of incentive opportunities and
to realize the benefits of health IT and meaningful use. There is
a fee for CITIA services; please contact Todd Thornburg (information
below) for more details.
Who should I contact for more information?
Todd Thornburg, PhD, Program Director
Health Sciences South Carolina
1320 Main Street, Suite 625
Columbia, SC 29201
www.HealthSciencesSC.org
General: 803.544.HSSC (4772)
Direct: 803.576.5917
Fax: 803.576.5577
thornbur@mailbox.sc.edu
CITIA partners
HSSC established and directs the
CITIA program as part of its goal to use health information exchange/technology,
quality improvement, clinical effectiveness programs, and patient
safety activities to improve South Carolina’s health status, education,
workforce development, and economic wellbeing.
Along with HSSC, the following
partners will provide direct services as part of the CITIA program:
The South Carolina Primary
Health Care Association (SCPHCA)
The South Carolina Primary Health Care
Association (SCPHCA) was formed to provide
health care services to medically underserved areas of the state.
SCPHCA-affiliated community, mental, migrant health, and homeless
Federally Qualified Health Centers are an integral part of the state’s
overall health care system; SCPHCA will support these institutions
as a partner in CITIA.
The South Carolina Office
of Rural Health (SCORH)
The South Carolina Office of Rural Health
(SCORH) serves as a single point of contact for rural health efforts
in the state. SCORH is available to serve all rural providers; its
role in CITIA is primarily to support certified Rural Health Clinics
and Critical Access Hospitals.
The Carolinas Center for Medical
Excellence (CCME)
The Carolinas Center
for Medical Excellence (CCME) is the Quality
Improvement Organization for South Carolina. CCME is vendor-neutral
and experienced in EHR selection and implementation in primary care
practices. CCME has been helping South Carolina primary care practices
adopt EHR systems since 2005. CCME’s role in CITIA will focus on
supporting primary care practices with one to ten providers.
Other partners include the following:
The South Carolina Area Health
Education Consortium
The South Carolina Area
Health Education Consortium will provide
education and outreach services to inform the health care community
of CITIA and its services.
The Lakelands Rural Health
Network
The Lakelands Rural Health
Network is operating an Internet-based,
authenticated, peer-to-peer computer system and search engine for
information on patient health, demographics, and related topics.
This group will also provide support on issues related to interoperability,
connectivity, privacy, and security.
Clemson University
Representatives from Clemson
University will support workflow redesign
in small rural hospitals during EHR implementation.
The South Carolina Technical
College System
The South Carolina Technical
College System will work to develop training
opportunities statewide for practice staff that may need additional
training on the use of EHR technology.
Benefits
for medical practices
Electronic Health Records, (EHRs)
and health information exchange can help clinicians provide higher
quality and safer care for their patients and create tangible enhancements
for their practices. By adopting electronic health records in a
meaningful way, clinicians can know more about their patients, make
better decisions, and save money. Other benefits include the following:
- Quick access to patient records from inpatient
and remote locations for more coordinated, efficient care.
- Enhanced decision support with clinical alerts,
reminders, and medical information.
- Safer, more reliable prescribing.
- Interface with labs, registries, other EHRs,
and Health Information Exchanges (HIEs).
- Legible, complete documentation that facilitates
accurate coding and billing.
- Enhanced privacy and security of patient data
with appropriate training and policies.
- Time saved and costs reduced within the practice.
- Performance-improving tools for best practices.
- Real-time quality reporting in compliance
with federal and state agency requirements.
Potential for better-Informed clinical decisions
According to a national survey
of physicians, when all patient information is in one place, physicians
can make well-informed treatment decisions quickly and safely:
- 97% of physicians in the survey reported that
EHRs contributed to timely access to medical records and 82% reported
that EHRs positively affected the quality of clinical decisions.
- 80% reported that EHRs averted a known drug
allergic reaction, and 71% avoided a potentially dangerous drug
interaction.
- In addition, by increasing
adherence to guideline- or protocol-based care, delivery improvements
ranged from absolute increases of 5 to 66 percentage points, with
most clustering in the range of 12 to 20 percentage points.
Improved Care Coordination and Communication
One in seven hospitalizations
results from missing clinical information.3
Ready access to a comprehensive patient record allows the physician
to effectively coordinate care and communicate with patients. Physicians
using fully functional EHRs have reported the following benefits:
- Six months after EHR implementation, 72.4%
reported being in agreement on treatment goals and plans with
other involved clinicians, compared to 56% of clinicians without
EHRs.
- 72% reported that EHRs positively affected
communication with patients.
- A recent article indicated that a gradual
EHR implementation resulted in maintaining positive patient-physician
relationships and fostering the sharing of medical information.
Long-term savings
While EHRs require a significant upfront investment
for technology and training, several studies have shown that EHRs
save practices money over time:
- In a 5-year cost-benefit model, EHR implementation
in a primary care practice resulted in an estimated net benefit
of $86,400 per provider from savings in drug expenditures, improved
utilization of radiology tests, better capture of charges, and
decreased billing errors.
- In an internist’s practice, even with a bumpy
implementation, an initial EHR system investment resulted in $65,000
in cost savings annually.
Providers with fully implemented
EHRs describe welcomed time savings from reduced chart chasing,
transcribing, and phone conversations with labs or pharmacies.
They also recount improved accuracy in coding and a decreased reporting
burden.
Why an EHR now?
Though the initial costs and implementation
challenges are considerable, delaying implementation today may create
additional resource drains tomorrow. The availability of an EHR
may soon be a “minimum standard” for new physicians, public and
private payers, and patients.
- The 2009 Future Physicians of America survey
found that 90% of medical students consider it important or very
important to have an EHR system where they choose to practice.
- EHRs are an essential component of reform-related
efforts such as Accountable Care Organizations.
- An operating EHR will be essential to participation
in both the public and private pay-for-performance programs expected
in the future.
- Medicare and Medicaid penalties will be imposed
in 2015 if EHRs are not being meaningfully used.
- 42% of consumers are interested in establishing
an online connection to their physician through a personal health
record, and 55% of consumers want the ability to communicate online
with physicians.
References
1 DesRoches
CM, et al. “Electronic Health Records in Ambulatory Care – A National
Survey of Physicians.” New England Journal
of Medicine, 2008.
2 Chaudry B, et
al. “Systematic Review: Impact of Health Information Technology
on Quality, Efficiency, and Costs of Medical Care.” Annals
of Internal Medicine, 2006.
3 Smith PC, et
al. “Missing clinical information during primary care visits.” Journal
of the American Medical Association. 2005.
4 Graetz I, et
al. “Care Coordination and Electronic Health Records: Connecting
Clinicians.” American Medical Informatics
Association 2009 Symposium Proceedings,
2009.
5 Shield R, et
al. “Gradual Electronic Health Record Implementation: New Insights
on Physician and Patient Adaptation.” Annals
of Family Medicine, 2010.
6 Wang S, et al.
“A Cost-Benefit Analysis of Electronic Medical Records in Primary
Care.” American Journal of Medicine,
2003.
7 Baron RJ, et
al. “Electronic Health Records: Just around the Corner? Or over
the Cliff?” Annals of Internal Medicine,
2005.
8 Epocrates. “4th
Annual Future Physicians of America.” www.epocrates.com,
2009.
9 Keckley P, Eselius
L. “2009 Survey of Health Care Consumers: Key Findings, Strategic
Implications.” Deloitte
Center for Health Solutions, 2009.
HSSC Solicits Vendor
Inputs for Regional Extension Center Program
Health Sciences South Carolina (HSSC),
in conjunction with partner organizations, has established South
Carolina's regional extension center to assist implementation of
electronic health record (EHR) systems in primary care practices
throughout the state of South Carolina. The regional extension center
system is known as CITIA-SC (Center for Information Technology Implementation
Assistance in South Carolina; and has been organized per ONC Guidance
CFDA 93.718. Primary care providers can find out more about this
program and register for support by going
to http://www.citiasc.org
and clicking on the banner "Apply Online."
As a part of this service, CITIA
is performing Vendor Selection and Group Purchasing as outlined
in the guidance and assists the state’s primary care physicians
with the selection of appropriate electronic health records systems.
The program also provides support during the implementation of those
systems into their practices. This includes training medical and
administrative staff on workflow design and the use of the systems
to maximize utilization in terms of improved
patient care, safety, and operating efficiency.
Note: The window for vendor submissions
for Round 3 of the vendor selection process ended at midnight, September
30, 2011 (9/30/2011). There will be no further rounds. No vendor
submissions will be accepted after midnight 9/30/2011.
EHR vendors interested in participating
in the CITIA Regional Extension Center
program should contact Mike Randall (msrandall@HealthSciencesSC.orgThis
e-mail address is being protected from spambots. You need JavaScript
enabled to view it ). In order to be considered
for this exercise, candidate EHR vendors MUST fill in an electronic
Vendor Input Form.
A summary of the
vendor selection process is given below:
-
The vendor selection and group
purchasing (VSGP) process is divided into 4 stages. The 4 stages
comprise a complete cycle or "round" of the VSGP process. Once
CITIA completes a round of these 4 stages, it starts another
round so as to ensure that the products recommended are the
best possible over time (i.e., new and better products are always
anticipated) as well as to ensure that any gaps in product offerings
are addressed. Rounds may run concurrently, as well.
Stage 1 is an initial evaluation stage and involves input by
candidate vendors via an electronic survey (the
CITIA Stage 1 Survey). Stage 1 is
focused on the general overview of the company and product.
After review of Stage 1 inputs by the CITIA VSGP Committee,
Stage 2 vendor candidates are selected. Each Stage 2 vendor
then submits a formal proposal as well as a Stage 2 Vendor Input
(the
CITIA Stage 2 Vendor Survey), related
to product functionality. Additionally, each Stage 2 vendor
candidate performs a product demonstration of six different
scenarios, and their performances are scored using an NIH scoring
model. The VSGP Committee then selects which candidates proceed
to Stage 3. Stage 3 of the process involves vendor submission
of a Stage 3 Vendor Input that is used as a basis for negotiation
of contracts offered to CITIA’s customers. Additional vetting
occurs within Stage 3 as well with regard to customer satisfaction
(Stage
3 Customer Satisfaction Survey),
and each vendor submits a proposed contract for CITIA customers
based on discussion of the vendor’s Stage 3 input with CITIA
(the
CITIA Stage 3 Vendor Survey). After
negotiation with CITIA is complete, each vendor will have a
contract in place with CITIA to offer to its customers. Each
vendor that has successfully advanced through the contracting
process (Stage 3) will progress on to Stage 4. Stage 4 is product
rollout, the beginning of the partnership between CITIA and
the approved vendors, and CITIA customers will begin to engage
recommended vendors to start the process of installation of
their respective products.
More on the Review Process
The CITIA review process is designed
to ensure that EMR vendor products submitted for review are evaluated
on the basis of a process that is fair, equitable, timely, and free
of bias. The process is based on the peer-review process used by
the National Institutes of Health (NIH). The review panel is composed
of a group of twenty-six professionals who have expertise in areas
relevant to the many aspects of EMR; IT infrastructure, purchasing,
implementation, and use within a primary care practice setting (including
quality reporting). There are several stages of review. The first
stage is designed to acquire a general idea of the company's history,
market penetration, IT platform, and other general relevant information.
The second stage is designed to get more information about functionality
and includes a two-hour demonstration. Stage 3 is designed to further
establish specific wording for contracts and best pricing. Only
vendor products that are favorably recommended by the committee
through all three stages will be identified as a fully vetted product
by the CITIA program.
CITIA vendor review
committee has a designated chair (Michael Randall) and co-chair
(Todd Thornburg) for meetings. The chair or co-chair serves as moderator
of the discussion of functional and technical merit of the products
under review.
Reviewers:
- Declare Conflicts of Interest with regard
to any and all applicants (there were none for any vendor product
reviewed).
- Receive access to all information supplied
by applicants as well as various reports and evaluation data available
from other sources regarding vendor products.
- Prepare questions and comments for evaluation
discussions.
- Assign a numerical score to each review criterion
after vendor demonstrations.
- Make recommendations concerning the functional
and technical merit of products under review in the form of final
voting (yes or no) and ranking their preferred vendor products
into a list of most preferred to least preferred.
Peer Review Meeting Procedures:
- Applications are reviewed based on established review criteria
(questionnaires, surveys, or clinical scenarios depending on the
stage).
- Primary reviewers summarize their prepared comments for the
entire group prior to group discussions.
- For review of product demonstrations (a portion of Stage 2 review),
at least one primary care physician is present for each demonstration.
Those members present for the vendor demonstration are considered
the primary reviewers for that stage of review for that product.
- For completion of Stage 2, the larger committee discusses each
product taking into account multiple sources of information including
comments and scoring from primary reviewers.
- An open discussion follows.
- Final scoring and ranking of overall utility is conducted by
private ballot.
- Scores and ranking are presented for discussion and final selections
for Stage 3 identified.
- Stage 3 is carried out in a similar manner with review focused
on data related to contract language and best pricing.
Scoring:
The scoring system used for Stage
2 demonstrations is similar to that used in NIH reviews (the
CITIA Stage 2 Vendor Demonstration Score Sheet).
The following guidance is given to reviewers to determine individual
review criterion and to determine an overall score:
Impact |
Score |
Descriptor |
Additional Guidance
on Strengths/Weaknesses |
High |
1 |
Exceptional |
Exceptionally
strong with essentially no weaknesses |
2 |
Outstanding |
Extremely
strong with negligible weaknesses |
3 |
Excellent |
Very strong
with only some minor weaknesses |
Medium |
4 |
Very Good |
Strong
but with numerous minor weaknesses |
5 |
Good |
Strong
but with at least one moderate weakness |
6 |
Satisfactory |
Some strengths
but also some moderate weaknesses |
Low |
7 |
Fair |
Some strengths
but with at least one major weakness |
8 |
Marginal |
A few strengths
and a few major weaknesses |
9 |
Poor |
Very few
strengths and numerous major weaknesses |
Minor Weakness: An
easily addressable weakness that does not substantially lessen
impact
Moderate Weakness: A
weakness that lessens impact
Major Weakness: A
weakness that severely limits impact
|
Product Review Appeals Process:
The CITIA EHR product review appeals
process is designed to address circumstances in which an EHR vendor
wishes to have their EHR software product, previously submitted
and reviewed during a CITIA EHR Vendor Selection Round, considered
for a second review by the Vendor Selection Committee (VSC):
Step 1:
The EHR vendor must submit a letter to CITIA, stating that they
want a second review to be given to their software product. The
letter must provide reasons why the vendor feels this second review
is necessary. Examples of acceptable reasons include (but are not
limited to):
- technical difficulties during the product demonstration that
were not the fault of the vendor or product, which resulted in
a degradation of product functionality;
- recent, significant changes to product functionality; or
- recent ONC certification of the EHR software product.
Step 2:
The EHR vendor’s appeal will be presented to the CITIA Program Director
for review. The Program Director may request input from the VSC.
If the Program Director deems a further review appropriate, the
product will be added to the list of products being reviewed in
the next round. If no further rounds are scheduled for the upcoming
months, the Program Director and VSC may decide on an additional
review as they see fit.
Step 3:
CITIA will notify the vendor of the VSC’s findings and next steps,
if any.
Electronic Health Records
(EHR) information and resources
EHR incentives
Registration guides
Attestation
Meaningful use
Additional information
|
